Miller Valentine Group | Total Real Estate Solutions

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Vendor Application Form 

General Company Information
*Required Fields

Firm Name:
Street Address:
City:
State:
Zip:
Business Phone:
Business Fax:
Website:
Annual Sales Volume:
Scopes of Work Performed:
List all C.S.I. Divisions that apply to your business:
Are you a small business enterprise?
  
In which of these markets does your company work? (check all that apply)
   
   
   
   
  
Remittance/Payment address (if different from above):
City:
State:
Zip:
Incorporated:
  
Federal Tax ID#:

Individuals with your firm who would do business with Miller-Valentine:
(Include Sales Contacts, Project Managers, CAD Operators, Accounts Payable, Shipping Manager, etc.)

1st Contact Information
Contact Name:
Contact Title:
Business Phone:
Business Fax:
Mobile Phone:
Email:
2nd Contact Information
Contact Name:
Contact Title:
Business Phone:
Business Fax:
Mobile Phone:
Email:
3rd Contact Information
Contact Name:
Contact Title:
Business Phone:
Business Fax:
Mobile Phone:
Email:
Submit form to the following office location:*